Key result
Inflammatory biomarkers linked to increased risk of post-EVAR complications and adverse sac remodeling.
Why the study?
Long-term durability of endovascular aneurysm repair (EVAR) is limited by endoleaks, adverse aneurysm sac remodeling, and reinterventions, motivating an evaluation of whether inflammatory biomarkers can help predict these complications.
Do inflammatory biomarkers predict complications (such as post-implantation syndrome, endoleaks, and adverse aneurysm sac remodeling) in patients with abdominal aortic aneurysm undergoing endovascular aneurysm repair?
Do inflammatory biomarkers predict complications (such as post-implantation syndrome, endoleaks, and adverse aneurysm sac remodeling) in patients with abdominal aortic aneurysm undergoing endovascular aneurysm repair?
Inflammatory biomarkers are associated with post-implantation syndrome, persistent type II endoleaks, and adverse sac remodeling after EVAR, suggesting they may complement—though not replace—imaging surveillance.
Answers are grounded in this paper and cite their sources.
May support biomarker use in post-EVAR surveillance; hypothesis-generating and requires prospective validation before adoption.
Endovascular aneurysm repair (EVAR) reduces early morbidity and mortality in anatomically suitable patients with infrarenal abdominal aortic aneurysm, but long-term durability is limited by endoleaks, adverse aneurysm sac remodeling, and the need for reinterventions. This focused narrative review examines whether inflammatory biomarkers can help predict these complications. The evidence supports two biologically related but clinically distinct settings. First, post-implantation syndrome (PIS) is an early sterile inflammatory response. Higher preoperative white blood cell (WBC) count, C-reactive protein (CRP), and systemic inflammatory response index (SIRI), along with greater new-onset thrombus, have been associated with its occurrence. Postoperative CRP, interleukin-6 (IL-6), and leukocyte changes reflect its intensity. Second, persistent type II endoleak and adverse sac behavior have been linked to systemic inflammatory disease, neutrophil-to-lymphocyte ratio (NLR), cytokines including interleukin-1, interleukin-8, and monocyte chemoattractant protein-1, and dynamic matrix metalloproteinase (MMP) profiles. Serial CRP changes and higher preoperative NLR and platelet-to-lymphocyte ratio (PLR) have also been associated with sac expansion or failure to regress. However, acute PIS does not consistently predict late endoleak or sac expansion, and most biomarker studies are small, single-center, and heterogeneous. Biomarkers may therefore complement, but cannot replace, imaging surveillance. Standardized prospective studies are needed to validate temporal biomarker panels and determine whether they improve clinical decision-making.
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Kukliński et al. (2026) conducted a review in Infrarenal abdominal aortic aneurysm undergoing endovascular aneurysm repair (EVAR). Inflammatory biomarkers (e.g., WBC, CRP, SIRI, IL-6, NLR, PLR, MMPs) vs. Imaging surveillance was evaluated on Post-EVAR complications including post-implantation syndrome, persistent type II endoleak, and adverse aneurysm sac remodeling. Inflammatory biomarkers (CRP, NLR, cytokines, MMPs) are associated with post-EVAR post-implantation syndrome, type II endoleaks, and sac expansion, complementing imaging surveillance.
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